Pediatrics International最新文献

Background: A target unplanned extubation (UE) rate of <1/100 ventilator days has been recommended. Our hospital has 21 NICU beds (12 beds in NICU 2 and 3 for extremely low birth weight [ELBW] infants). In 2020, we experienced an abrupt UE increase, leading to the initiation of the Stop UNplanned eXtubation (SUNX) project. At that time, UE rate was 1.30/100 ventilator days. The aim of the SUNX project was to keep the low UE rate.

Methods: We collected data on UE rates from April 2019 to March 2024. The intervention was implemented through Plan-Do-Study-Act cycles. Cause analysis with the Pareto chart led to the drivers, we had to deal with: judicious use of sedations, Endotracheal tube (ETT) tape loosening, and stuff number during infant care. Additionally, we did simulation training for sudden SpO₂ decrease and UE event review. We also gathered data about ELBW infant admission and their NICU stay.

Results: The UE rate in total NICU was kept lower than 1/100 ventilator days after the intervention. After our intervention, we found no special cause variation. It meant that our intervention was not statistically significant. However, our intervention gradually penetrated into the NICU daily practices; judicious use of sedation, ETT tape template, body position change by two nurses, UE event review, and so on. We continued a systematic approach to preventing UE.

Conclusions: Although abrupt UE increase in 2020 might be a special cause variation, SUNX activities brought us systematic approach for UE prevention.

Background: Sleep and sleep habits in children are important in terms of bio-psycho-social aspects. The aim of this research was to develop a new scale under the name of the evaluation of sleep and sleep habits of children aged 6-12. 600 children aged 6-12 years constituted the sample of the study.

Methods: The parents of the children were asked to answer the question list in the sleep habits scale of 6-12-year-old children, in which sleep and sleep habits were evaluated, which was formed by the socio-demographic information from an expert opinion by the research team. To examine the reliability of the scale based on internal consistency, Cronbach and Omega alpha coefficients were calculated, and test-retest analysis and criterion validity were performed to determine the stability of the scale and whether it could make consistent measurements over time.

Results: In the correlation coefficient used as a test-retest reliability method, there were moderate and high levels of positive and significant correlations between the scores obtained from the first and second applications. According to the criterion validity findings, a moderately positive and significant relationship was found between the scores obtained from the overall sleep habits scale and the scores obtained from the overall child sleep habits questionnaire (r = 0.61; p < 0.01).

Conclusion: These results showed that the 6-12 age child sleep habits scale, which is a parent-reported scale, is a valid and reliable new scale that can evaluate sleep and sleep habits of children and screen for potential sleep problems.

Background: In Japan, as several important vaccines are still categorized as voluntary vaccines that require out-of-pocket payment, the vaccination coverage of voluntary vaccines is lower than that of routine vaccines. Thus, higher voluntary vaccination rates are desired. Herein, we used nationwide birth cohort data to create a voluntary vaccine risk score to identify high-risk individuals who were not vaccinated with voluntary vaccines.

Methods: The data from 74,733; 73,571; and 74,360 infants were analyzed for rotavirus, mumps virus, and influenza virus vaccinations, respectively. The risk score for non-vaccination of voluntary vaccines was created from the regression coefficients of the logistic regression models.

Results: The items included for the score resulted from the analysis were the mother's drug allergy history, mother's depression history, mother's educational background, father's educational background, household income, maternal smoking during pregnancy, paternal smoking during pregnancy, fertility treatment, number of siblings, maternal drinking at 1 month of age, maternal age, and maternal nationality. The mother's drug allergy history, mother's depression history, fertility treatment, maternal drinking at 1 month of age, and maternal nationality were factors not previously reported and associated with taking voluntary vaccine. The receiver operating characteristic curve of the risk score for non-vaccination of voluntary vaccines suggested that a score ≥16 predicted non-vaccinated infants for rotavirus, mumps virus, and influenza virus vaccines with 78.6%, 75.0%, and 74.5% sensitivity and 44.2%, 43.2%, and 37.1% specificity, respectively.

Conclusions: We developed a risk score for non-vaccination of voluntary vaccines consisting of 10 domains with high sensitivity but low specificity.

Background: Children have a greater risk of mental health problems in low/middle-income countries. Determining the risk factors and earlier identification of young children at high risk for behavioral problems are central to cost-effective intervention with positive long-term outcomes. The aim of this study was to examine the prevalence and risk factors of behavioral problems of preschoolers in three different cities located in eastern, western, and central Türkiye, a low/middle-income country.

Methods: In total, 300 children (4-6 years old) without any chronic diseases participated the study. The parents completed the Children's Behavior Checklist/4-18 (CBCL/4-18), the Children's Sleep Habits Questionnaire, the Pittsburgh Sleep Quality Index, and the Beck Depression Inventory. Daily activities were evaluated using questionnaires that were specifically developed for the present study.

Results: Based on the CBCL4-18, 12.3% of children were at high risk for behavioral problems. Paternal unemployment, screen time, maternal depressive symptoms, and maternal and child sleep problems were associated with internalizing behavioral problems; maternal depressive symptoms and watching videos on touch-screen devices were associated with externalizing behavioral problems. Total behavioral problems were associated with maternal unemployment, maternal depressive symptoms, being the eldest child, and child sleep problems.

Conclusion: Preventable risk factors such as daily activities and maternal mental health should be evaluated as well as sociodemographic factors among preschoolers who may be at high risk of behavioral problems. The results of this study contribute toward drawing attention to preventable risk factors in a low/middle-income country.

Background: ZNF384 rearrangements (ZNF384-r) are associated with distinct subgroups of B-cell precursor acute lymphoblastic leukemia (BCP-ALL) and the mixed phenotype of acute leukemia. Types of BCP-ALL with ZNF384-r exhibit common immunophenotypic characteristics, whereas their clinical features are not uniform and TCF3::ZNF384-positive patients show a significantly poorer steroid response and higher frequency of relapse, while EP300::ZNF384-positive patients exhibit a favorable response to conventional chemotherapy. Therefore, we aimed to investigate the differences in biological effects between these two ZNF384-r molecules.

Method: We transduced BCP-ALL cell lines with both TCF3::ZNF384 and EP300::ZNF384 by retrovirus-mediated gene transduction, and examined the biological effects.

Results: Flow cytometric analysis and RT-qPCR revealed down-regulation of CD10 in BCP-ALL cells after transduction with both TCF3::ZNF384 and EP300::ZNF384. The annexin-V binding apoptosis assay indicated that TCF3::ZNF384-, but not EP300::ZNF384-, expressing cells exhibited increased resistance to dexamethasone-induced apoptosis. By means of an oligonucleotide microarray and RT-qPCR, we observed that the transduction of TCF3::ZNF384, but not EP300::ZNF384, leads to significant enhancement of cyclin D2 (CCND2) gene expression in BCP-ALL cells, but no growth advantage was observed.

Conclusion: Our data suggest that the acquisition of dexamethasone resistance in BCP-ALL cell lines is an effect of TCF3::ZNF384 protein distinct from EP300::ZNF384. Other than the common functions of ZNF384-r that contribute to the development of leukemia with a lineage-ambiguous phenotype, TCF3::ZNF384 may exhibit a fusion partner-dependent function distinct from EP300::ZNF384 and participate in the formation of characteristic clinical features of TCF3::ZNF384-expressing ALL patients.

Background: Hereditary angioedema (HAE) is a rare genetic disorder that causes recurrent edema and abdominal/laryngeal attacks. However, the number of pediatric HAE cases is unknown. We aimed to assess the number of pediatric HAE and the actual status of pediatric HAE management in Japan.

Methods: A mail questionnaire survey was conducted on 142 clinicians (representatives of institutes) with previous experience in HAE management. The survey items included the number of pediatric patients who were treated for HAE, history of attacks and its impact on quality of life, the presence of untested pediatric relatives of adult patients, and unmet needs.

Results: In total, 69 representatives (49% of overall institutes) responded. Twenty-five (36% of respondents) had experience in pediatric HAE management. The number of cases managed by individual faculties ranged from 1 to 6, and most physicians (n = 16, 64% of faculties with patient(s)) reported the management of a single case only. There were 26 (8 male,16 female) patients with one or more attacks. Nineteen facilities (28% of respondents) reported one or more pediatric relative(s) of patients who were hesitant to screen. Further, physicians reported various unmet needs.

Conclusions: Pediatric HAE is managed in many facilities in a dispersed manner. In some cases, the pediatric relatives of patients diagnosed with HAE did not undergo screening. This study identified unmet needs and challenges that reflect the absence of specialized pediatric management. Hence, the standardization of pediatric HAE management is an urgent concern in Japan.

Background: The rapid increase in depression among adolescents is an urgent concern. This study examined the association between depression and digital device use, among adolescents. Furthermore, we explored the time thresholds of specific digital device use.

Methods: This cross-sectional study administered self-reported questionnaires to all 467 students of a junior high school in Japan. The Patient Health Questionnaire-9 was used to assess depression (cut-off values 0-4: no or minimal, 5-9: mild, 10-27: moderate to severe). Data on participants' dietary habits, sleep habits, physical activity, and time spent on digital devices (total, gaming, social media, and video watching) were obtained. Multiple logistic regression analysis was used to examine the abovementioned association.

Results: The response rate was 92.9% and data from complete case analyses with 357 participants were analyzed. Of the participants, 11.8% reported depressive symptoms. Lifestyle factors and digital device use were consistently associated with depression. Total time spent on any digital device was not significantly associated with depression, adjusted for selected lifestyles. However, ≥3 h of gaming (Adjusted odds ratio [AOR] 3.32 [95%CI, 1.66-6.65], p = 0.001) and social media use (AOR 2.56 [95%CI, 1.28-5.11], p = 0.008) on non-school days were significantly associated with depression, regardless of adjustment.

Conclusion: Moderate use of digital technology to avoid disrupting lifestyles is desirable for adolescents' mental health. Furthermore, gaming or social media use for ≥3 h was consistently significant factors. Health education to control these factors for <3 h is favorable to maintain mental health.